{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T20:11:22Z","timestamp":1792267882100,"version":"4.4.0"},"reference-count":23,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T00:00:00Z","timestamp":1722902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: There are several endovascular treatment options to treat aortic arch and thoracic aortic pathologies with custom-made or surgeon-modified aortic stent grafts. This study seeks to assess endovascular treatment methods for aortic arch and thoracic aortic pathologies with no acceptable proximal landing zone for standard thoracic endovascular aortic repair (TEVAR), comparing different treatment methods and evaluating technical success, intraoperative parameters and short-term outcomes. Methods: All patients undergoing elective or emergency endovascular treatment of aortic arch and thoracic aortic pathologies, with no acceptable landing zone for standard TEVAR, between 1 January 2010 and 31 March 2024, at the University Hospital D\u00fcsseldorf, Germany were included. An acceptable landing zone was defined as a minimum of 2 cm for sufficient sealing. All patients were not suitable for open surgery. Patients were categorized by an endovascular treatment method for a comprehensive comparison of pre-, intra- and postoperative variables. IBM SPSS29 was used for data analysis. Results: The patient cohort comprised 21 patients, predominantly males (81%), with an average age of 70.9 \u00b1 9 years with no acceptable proximal landing zone for standard TEVAR procedure. The most treated aortic pathologies were penetrating aortic ulcers and chronic post-dissection aneurysms. Patients were sub-grouped according to the applied procedure as follows: five patients with chimney thoracic endovascular aortic repair (chTEVAR), seven patients with in situ fenestrated thoracic endovascular aortic repair (isfTEVAR), six patients with custom-made fenestrated thoracic endovascular aortic repair (cmfTEVAR) and three patients with custom-made branched thoracic endovascular aortic repair (cmbTEVAR). Emergency procedures involved two patients. There were significant differences in the total procedure and fluoroscopy time, as well as in contrast agent usage among the treatment groups. cmfTEVAR had the shortest total procedure time, while chTEVAR exhibited the highest contrast agent usage. The overall mortality rate among all procedures was 9.5% (two patients) and 4.7% for elective procedures, respectively. Deaths were associated with either retrograde type A dissection or stent graft infection. Both patients were treated with chTEVAR. There was one minor and one major stroke; these patients were treated with isfTEVAR. No endoleak occurred during any procedure. The reintervention rate for chTEVAR was 20% and 0% for all other procedures during the in-hospital stay. The patients who were treated with cmfTEVAR had no complications, the shortest operating and fluoroscopy time, and less contrast agent was needed in comparison with other treatment methods. Conclusions: Complex endovascular procedures of the aortic arch with custom-made or surgeon-modified aortic stent grafts offer a safe solution, with acceptable complication rates for patients who are not suitable for open aortic arch repair. In terms of procedure-related parameters and complication rates, a custom-made fenestrated TEVAR is potentially advantageous compared to the other endovascular techniques.<\/jats:p>","DOI":"10.3390\/jcm13164594","type":"journal-article","created":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T11:54:19Z","timestamp":1722945259000},"page":"4594","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Comparative Evaluation of the Short-Term Outcome of Different Endovascular Aortic Arch Procedures"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8639-9873","authenticated-orcid":false,"given":"Artis","family":"Knapsis","sequence":"first","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine-University, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melik-Murathan","family":"Seker","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine-University, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hubert","family":"Schelzig","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine-University, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0379-8607","authenticated-orcid":false,"given":"Markus U.","family":"Wagenh\u00e4user","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine-University, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.avsg.2023.08.037","article-title":"Aortic Arch Debranching and Thoracic Endovascular Aortic Repair (TEVAR) For Type B Aortic Dissection","volume":"99","author":"Bashir","year":"2024","journal-title":"Ann. Vasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/j.jvs.2013.03.043","article-title":"Thoracic endovascular aortic repair with the chimney graft technique","volume":"58","author":"Hogendoorn","year":"2013","journal-title":"J. Vasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1177\/15266028211007475","article-title":"Gimme\u2019 the Loop: Modifications to the Squid-Capture Technique for Laser-Fenestrated Thoracic Endografting","volume":"28","author":"Mulorz","year":"2021","journal-title":"J. Endovasc. Ther."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1016\/j.jvs.2022.12.059","article-title":"Preliminary results from an Italian National Registry on the outcomes of the Najuta fenestrated aortic arch endograft","volume":"77","author":"Isernia","year":"2023","journal-title":"J. Vasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1016\/j.jvs.2016.03.410","article-title":"Branched versus fenestrated endografts for endovascular repair of aortic arch lesions","volume":"64","author":"Tsilimparis","year":"2016","journal-title":"J. Vasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1016\/j.athoracsur.2008.05.011","article-title":"Improving Results of Open Arch Replacement","volume":"86","author":"Sundt","year":"2008","journal-title":"Ann. Thorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1089\/sur.2017.089","article-title":"Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review","volume":"18","author":"Cheng","year":"2017","journal-title":"Surg. Infect."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"388","DOI":"10.5935\/0101-2800.20160062","article-title":"Contrast induced nephropathy","volume":"38","author":"Maccariello","year":"2016","journal-title":"Braz. J. Nephrol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S11","DOI":"10.1038\/sj.ki.5000368","article-title":"Contrast-induced nephropathy: Definition, epidemiology, and patients at risk","volume":"69","author":"Mehran","year":"2006","journal-title":"Kidney Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.2147\/CIA.S222948","article-title":"Outcomes of Chimney Technique for Aortic Arch Diseases: A Single-Center Experience with 226 Cases","volume":"14","author":"Huang","year":"2019","journal-title":"Clin. Interv. Aging"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Luo, M., Zhang, X., Fang, K., Guo, Y., Chen, D., Lee, J.T., and Shu, C. (2023). Endovascular aortic arch repair with chimney technique for pseudoaneurysm. BMC Cardiovasc. Disord., 23.","DOI":"10.1186\/s12872-023-03091-4"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Li, J., Xue, Y., Li, S., Sun, L., Wang, L., Wang, T., Fang, K., Luo, M., Li, X., and He, H. (2022). Outcomes of thoracic endovascular aortic repair with chimney technique for aortic arch diseases. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.868457"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1016\/j.jvs.2017.02.035","article-title":"First experience with the double chimney technique in the treatment of aortic arch diseases","volume":"66","author":"Wang","year":"2017","journal-title":"J. Vasc. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1524","DOI":"10.1016\/j.jvs.2020.01.072","article-title":"Early and midterm outcomes of in situ laser fenestration during thoracic endovascular aortic repair for acute and subacute aortic arch diseases and analysis of its complications","volume":"72","author":"Li","year":"2020","journal-title":"J. Vasc. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Hou\u00e9rou, T.L., Nana, P., Pernot, M., Guihaire, J., Gaudin, A., Lerisson, E., Costanzo, A., Fabre, D., and Haulon, S. (2023). Systematic Review on In Situ Laser Fenestrated Repair for the Endovascular Management of Aortic Arch Pathologies. J. Clin. Med., 12.","DOI":"10.3390\/jcm12072496"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Iida, Y., Hachiya, T., Oka, H., Inaba, Y., Miki, T., and Shimizu, H. (2023). Clinical outcomes of Najuta thoracic stent graft system for arch aneurysms. Front. Surg., 10.","DOI":"10.3389\/fsurg.2023.1167714"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1007\/s11748-022-01886-4","article-title":"Preemptive fenestrated endovascular repair aimed at perfusion of cervical branches in acute type B aortic dissection","volume":"71","author":"Toya","year":"2022","journal-title":"Gen. Thorac. Cardiovasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"384","DOI":"10.3400\/avd.oa.20-00102","article-title":"Long-Term Clinical Outcomes of Thoracic Endovascular Aortic Repair for Arch Aneurysms with the Najuta Thoracic Stent-Graft System","volume":"13","author":"Fukada","year":"2020","journal-title":"Ann. Vasc. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1694","DOI":"10.1016\/j.jvs.2018.09.028","article-title":"Initial results of thoracic endovascular repair for uncomplicated type B aortic ddissection involving the arch vessels using a semicustom-made thoracic fenestrated stent graft","volume":"69","author":"Fukushima","year":"2019","journal-title":"J. Vasc. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"081","DOI":"10.1055\/s-0038-1645881","article-title":"Endovascular Treatment of Various Aortic Pathologies: Review of the Latest Data and Technologies","volume":"27","author":"Maeda","year":"2018","journal-title":"Int. J. Angiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1016\/j.jvs.2022.08.018","article-title":"Applicability of endovascular branched and fenestrated aortic arch repair devices to treat residual type A dissection after ascending replacement","volume":"76","author":"Hauck","year":"2022","journal-title":"J. Vasc. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.ejvs.2009.05.002","article-title":"Present and Future of Branched Stent Grafts in Thoraco-abdominal Aortic Aneurysm Repair: A Single-centre Experience","volume":"38","author":"Verhoeven","year":"2009","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Kudo, T., Kuratani, T., Sawa, Y., and Miyagawa, S. (2022). Effectiveness and Minimal-Invasiveness of Zone 0 Landing Thoracic Endovascular Aortic Repair Using Branched Endograft. J. Clin. Med., 11.","DOI":"10.3390\/jcm11236981"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/16\/4594\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:30:42Z","timestamp":1760110242000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/16\/4594"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,6]]},"references-count":23,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["jcm13164594"],"URL":"https:\/\/doi.org\/10.3390\/jcm13164594","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,6]]}}}